SS16 - Redo Aortic Arch Repair: Comparative Early Outcomes following Open Versus Endovascular Approaches from a Regional Complex Aortic Center

Objectives: As survival following cardiac and aortic operations has improved, redo aortic arch repair is increasingly encountered. Although open repair offers durable long-term outcomes, risks related to redo sternotomy, circulatory arrest, and prolonged cardiopulmonary bypass can be significant. Total endovascular arch repair using branched/fenestrated endografts has emerged as a less invasive alternative, yet comparative outcomes between redo open and endovascular arch repair remain poorly defined.

Methods: We performed a retrospective review of consecutive patients with prior median sternotomy who underwent total arch replacement with frozen elephant trunk (TAR-FET), or arch fenestrated, branched thoracic endovascular repair with the proximal seal in zone 0 (A-FBTEVAR) at a single tertiary aortic center between January 2019 and August 2025. The primary outcome was 30-day mortality and stroke. Secondary outcomes included major adverse events (MAE), and resource utilization including length of stay, operative time, blood product usage.

Results: A total of 124 patients were included, comprising 96 redo open arch repairs and 28 endovascular arch repairs. Patients undergoing endovascular repair were significantly older (74.7 ± 11.4 vs 55.8 ± 12.2 years; p< 0.001) and had higher rates of chronic obstructive pulmonary disease and atrial fibrillation (Table). Unadjusted 30-day mortality (14.3% vs 8.3%; p= 0.47) and stroke (17.9% vs 9.4%, p= 0.305) trended higher for the A-FBTEVAR group. Redo TAR-FET group had significantly higher operative time, blood product utilization, and ICU length of stay (p < 0.001). MAE occurred in 26.4% (n= 33) of patients, including 29.2% (n= 28) in the redo TAR–FET group and 17.9% (n= 5) in the A-FBTEVAR group (p = 0.33). When adjusted for age, COPD, and atrial fibrillation, there was no significant association between the repair technique and 30-day mortality (aOR 0.51, 95% CI 0.08–2.77; p= 0.45) or postoperative stroke (aOR 2.12, 95% CI 0.46–9.11; p= 0.33) (Figure).

Conclusions: : In this single-center experience, older patients with greater comorbidity burden were more likely to undergo A-FBTEVAR, rather than redo TAR-FET. Despite these differences, adjusted 30-day mortality and stroke were similar between approaches, while endovascular repair was associated with reduced operative burden and faster recovery, supporting its role as a viable alternative in high-risk redo patients.